Men taking long-acting chronic pain meds five times more likely to have low testosterone levels

January 31, 2013

Low testosterone levels occur five times more often among men who take long-acting instead of short-acting opioids for chronic pain, according to a new Kaiser Permanente study published in The Clinical Journal of Pain.

While it has been known that cause low testosterone in men, this study is the first to show a significant difference in risk between short-acting (immediate release) and long-acting opioids.

The 81 men in the retrospective study were between 26 and 79 years old (median age 51) and were seen in the chronic-pain clinic at Kaiser Permanente's Santa Rosa Medical Center (Calif.) between January 2009 and June 2010. All of the participants had been on a stable dose of an opioid for at least three months, and none had a previous diagnosis of low testosterone. A larger of more than 1,500 male pain patients is currently under way.

"There's a large gap in the evidence base with regard to opioids," said Andrea Rubinstein, MD, of the Departments of Chronic Pain and Anesthesiology, Kaiser Permanente Santa Rosa Medical Center. "More safety and efficacy studies are needed. We need to know how we can prescribe these very useful medications in a way that brings the greatest benefits to our patients, without introducing additional risks."

Once prescribed primarily to , the use of opioid-based medications such as () and hydrocodone (Vicodin) for treating chronic, non-cancer pain has increased dramatically in recent decades. An estimated 4.3 million Americans use opioids on a daily basis for pain.

"For years, doctors have been encouraged to prescribe long-acting opioids rather than short-acting opioids because we believed they were safer, had less abuse potential, and offered more consistent pain control, but no study has ever been able to support this practice," Dr. Rubinstein said.

The study compared the use of short-acting opioids, which immediately release the and are taken every four to six hours, and long-acting opioids, which slowly release the pain medication and are taken every eight to 12 hours.

A healthy young man should have testosterone levels between 300 and 800 nanograms per deciliter (ng/dL); in this study, low testosterone, also known as hypogonadism, was defined as less than 250 ng/dL. have been associated with decreases in muscle mass, bone density (osteoporosis or osteopenia), cognition, mood, libido (sex drive) and general quality of life.

Seventy-four percent of the men on long-acting opioids had low , compared with 34 percent of the men using short-acting opioids. After controlling for daily dosage and body mass index, the study found that the odds of having low testosterone were 4.78 times greater for men taking a long-acting opioid than a short-acting opioid. Dose was not associated with an increased risk of low testosterone.

"These medications work well for short-term, acute pain," said Dr. Rubinstein. "It has long been extrapolated that they can also be used safely long-term to control . We are now finding that the long-term use of opioids may have important unintended health consequences."

Explore further: Use of opioid painkillers for abdominal pain has more than doubled

Related Stories

Use of opioid painkillers for abdominal pain has more than doubled

November 29, 2011
Across U.S. outpatient clinics between 1997 and 2008, opioid prescriptions for chronic abdominal pain more than doubled, according to a new study in Clinical Gastroenterology and Hepatology, the official journal of the American ...

Opioids linked to higher risk of pneumonia in older adults

September 22, 2011
Opioids -- a class of medicines commonly given for pain -- were associated with a higher risk of pneumonia in a study of 3,061 adults, aged 65 to 94, e-published in advance of publication in the Journal of the American Geriatrics ...

Study determines critical skills for PCPs to safely manage opioid risk in chronic pain patients

March 16, 2012
Primary care physicians are faced with treating a large proportion of chronic pain patients, but many do not often have specific training in the assessment and management of chronic pain, including the use of opioid medications ...

Adolescents and young adults with mental health disorders at risk of long-term opioid use

June 6, 2012
Long-term use and abuse of opioid painkillers, such as OxyContin and Vicodin, has markedly increased in the United States in the last two decades. Of note, prescription opioids constitute 86.9 percent of prescription drug ...

Recommended for you

Drug for spinal muscular atrophy prompts ethical dilemmas, bioethicists say

December 11, 2017
When the Food and Drug Administration approved the first drug for people with spinal muscular atrophy a year ago, clinicians finally had hope for improving the lives of patients with the rare debilitating muscular disease. ...

FDA's program to speed up drug approval shaved nearly a year off the process

December 7, 2017
Speeding the pace at which potentially lifesaving drugs are brought to market was a rallying cry for Donald Trump as a candidate, and is a stated priority of his Food and Drug Administration commissioner, Dr. Scott Gottlieb. ...

Dangers of commonly prescribed painkillers highlighted in study

December 6, 2017
Commonly prescribed painkillers need to be given for shorter periods of time to reduce the risk of obesity and sleep deprivation, a new study has revealed.

Viagra goes generic: Pfizer to launch own little white pill

December 6, 2017
The little blue pill that's helped millions of men in the bedroom is turning white. Drugmaker Pfizer is launching its own cheaper generic version of Viagra rather than lose most sales when the impotence pill gets its first ...

Surgery-related opioid doses can drop dramatically without affecting patients' pain

December 6, 2017
Some surgeons might be able to prescribe a third of opioid painkiller pills that they currently give patients, and not affect their level of post-surgery pain control, a new study suggests.

Four-fold jump in deaths in opioid-driven hospitalizations

December 4, 2017
People who end up in the hospital due to an opioid-related condition are four times more likely to die now than they were in 2000, according to research led by Harvard Medical School and published in the December issue of ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.